In response to “one of the boldest steps yet” that the Trump administration has taken to sabotage the Affordable Care Act, media, experts, and policymakers have continued to speak out against the Trump administration’s new 1332 waiver guidance.
Below is a look at what experts are saying:
Sarah Lueck, Senior Policy Analyst At Center On Budget And Policy Priorities: “Potentially What This Guidance And Concept Ideas Are Saying Is: ‘States, You Can Try To Do What Was Rejected In Congress.'” “‘Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities, told me the concepts were reminiscent of some ideas that emerged during the repeal-and-replace debate last year. She said they would allow states to ‘pursue policies that could reduce subsidies available for vulnerable populations, offer inadequate coverage options or leave people with unaffordable coverage…Potentially, what this guidance and concept ideas are saying is: ‘States, you can try to do what was rejected in Congress,’ ‘ Lueck added. ‘But whether it’s the bad ideas from the repeal debate or returning to the pre-ACA-style market, it’s not going to fare as well for people if they have a preexisting condition, if they’re older, low-income — those concerns are very real.’.” [Washington Post, 11/30/18]
Timothy Jost, Washington And Lee University Law Professor: With New Proposal, “Invariably, The Coverage Is Going To Be More Expensive For People Who Really Need Comprehensive Coverage.” “Invariably, the coverage is going to be more expensive for people who really need comprehensive coverage…As soon as any state proceeds to go somewhere with this, there will be legal challenge.” [Kaiser Health News, 11/29/18]
Sabrina Corlette, Senior Research Fellow At Georgetown University’s Center On Health Insurance Reforms: Latest Recommendations Continue A ‘Trend’ In The Trump Administration To ‘Break Up The Basic Framework Of The ACA. “‘What would happen is those products … will attract healthier, younger enrollees, leaving a smaller and sicker pool in the ACA-compliant plans,’ Corlette said. She thinks that this will lead to one of two consequences that could harm people with preexisting illnesses. ‘You’re an insurance company and you’re saying, ‘Okay, I can either offer these noncompliant options, get all the healthy people and subsidies to boot, or I can offer these ACA plans and get all the sick people.’ What are you going to do?,’ Corlette said. ‘You’re going to drop the ACA plans and offer these noncompliant plans. Or you can keep offering your ACA-compliant plans and jack up the price.’ Corlette said the latest recommendations continue a ‘trend’ in the Trump administration to ‘break up the basic framework of the ACA…They’ve been punching holes in the ACA’s minimum floor of protections for a while now,” she said. “I would say that this latest 1332 guidance and concepts is just part of that general push by the administration to sort of fray that basic national standard of protections and requirements.’” [Washington Post, 11/30/18]
University Of Michigan Law Professor Nicholas Bagley Warns That Trump’s Suggested Waivers May Not Be Legally Sound. “Would a future waiver be vulnerable? You bet…The ACA says that a state waiver must provide coverage at least as comprehensive as what the ACA provides. A state waiver that means loads of sick people won’t be able to get coverage, or won’t be able to get affordable coverage, shouldn’t pass muster.” [HuffPost, 11/30/18]
How the media is continuing to cover the new guidelines:
HuffPost: Trump Administration Announcement Carries On “Crusade Against ‘Obamacare’ That Voters Seemed To Reject Soundly In This Month’s Midterm Elections.” “The Trump administration just made it easier for states to rewrite some of the Affordable Care Act’s insurance rules, carrying on with a crusade against “Obamacare” that voters seemed to reject soundly in this month’s midterm elections…And among the 1332 waiver models that CMS published on Thursday was a prototype in which people could use federal tax credits to pay for alternative insurance options that exclude key benefits, like full prescription coverage or inpatient psychiatric care, and aren’t generally available to people with pre-existing conditions…Consumers who buy the plans can still face crushing medical bills if they get injured or sick and require treatment the policies don’t cover. Meanwhile, people who need or want more comprehensive coverage can end up paying more for their policies because the insurers who sell them have to raise premiums when healthier customers flock to the skimpier plans. A major goal of the Affordable Care Act was to avoid these problems ― or, at the very least, to mitigate them. By encouraging enrollment into these less-comprehensive plans, experts warned Thursday, the administration was all but certainly making it more difficult for the law to function as intended.” [HuffPost, 11/30/18]
Washington Post: Trump Administration Is Providing States With “Roadmap” For How They Can Sidestep Parts Of ACA. “The Trump administration is providing states with a roadmap for how they can sidestep parts of the Affordable Care Act in the name of giving more power back to the states. But critics fear the move will undermine key consumer protections established by the 2010 health-care law.” [Washington Post, 11/30/18]
CNN: “The Trump Administration Is Laying Out For States How They Can Use Their Sweeping New Powers To Overhaul — And Likely Undermine — Obamacare.” “The Trump administration is laying out for states how they can use their sweeping new powers to overhaul — and likely undermine — Obamacare…It’s the latest move by the Trump administration to weaken the Affordable Care Act from the inside after the collapse of Republican efforts to repeal it altogether, this time by targeting the subsidies, which are considered crucial to keeping insurance markets working well. The new waiver powers could widen the divide in health care coverage among the states, which the Affordable Care Act sought to unify with nationwide standards for benefits and assistance. Red states may seek to provide greater access to alternative plans, while blue states could try to bolster their Obamacare markets.” [CNN, 11/29/18]
New York Times: New Policy “Upends A Premise Of The Affordable Care Act.” “The new policy outlined by the administration on Thursday upends a premise of the Affordable Care Act: that federal subsidies can be used only for insurance that meets federal standards and is purchased through public marketplaces, also known as insurance exchanges. Under the new policy, states could use federal subsidies to help people pay for employer-sponsored insurance. Consumers could combine federal funds with employer contributions to buy other types of insurance.” [New York Times, 11/29/18]
Slate: “The New Guidance Is Just The Latest Step In The Trump Administration’s Long Quest To Dismantle Much Of Obamacare Through Executive Fiat.” “One of the administration’s suggestions is to restructure the law’s insurance subsidies, which help low and middle-income Americans pay their monthly premiums, so that they’re tied to age instead of income. (This would effectively give more help to high-earners and less to low-earners). Another is to let people spend those subsidies on cheap health plans that don’t meet all of Obamacare’s coverage requirements. (This would likely drive up costs for some people who needed more comprehensive coverage). It’s not clear that these sorts of changes would hold up in court. But if they did, such moves would likely undercut Obamacare’s consumer protections, including for Americans with pre-existing conditions. The new guidance is just the latest step in the Trump administration’s long quest to dismantle much of Obamacare through executive fiat.” [Slate, 11/29/18]
Kaiser Health News: Experts Predict Ideas Would Foster Parallel Market, Drive Up Premiums For Those Who Remain In ACA Plans. “Still, coupled with other ongoing efforts by the Trump administration to gut Obamacare, policy experts predict the ideas would further foster a parallel market of cheaper, less robust coverage that could draw younger or healthier consumers, but drive up premiums for those who remain in ACA market plans.” [Kaiser Health News, 11/29/18]
Axios: “This Is One Of The Administration’s Most Significant Anti-ACA Moves To Date — If It Works.” “This is one of the administration’s most significant anti-ACA moves to date — if it works. States that ask for everything they’re now allowed to, and get it, could set up an insurance market that looks a lot different from what the ACA envisioned.” [Axios, 11/30/18]
BuzzFeed News: Administration’s Guidance Is “One Of The Boldest Steps Yet” Trump Has Taken To Sabotage ACA. “It is one of the boldest steps yet taken by the Trump administration to take down the building blocks of the Affordable Care Act despite the law remaining on the books…The Obama administration had taken the opposite approach. While it allowed for people to have insurance plans outside of the ACA’s regulations in certain circumstances, the individual markets were bolstered because only regulated plans qualified for subsidies. Since taking office, Trump has encouraged the proliferation of skimpier off-market plans. With ACA repeal off the table for now, this has become the foremost health policy fight in Washington.” [BuzzFeed News, 11/29/18]
The Independent: After Failing To Dismantle The ACA, The Trump Administration Is Now Offering States Suggestions On How To Undermine It. “The federal government has issued suggestions to help states undermine the waiver system of Obamacare, helping to weaken the implementation of the act. Donald Trump and the republican administration tried and failed to completely dismantle the Affordable Care Act, also known as Obamacare, soon after Mr Trump was sworn in as president. However, the administration is now helping states apply for alternative types of insurance, which could ultimately undermine Obamacare.” [The Independent, 11/29/18]
And how policymakers are responding:
Reps. Frank Pallone And Richard Neal, Top Democrats On House Energy And Ways And Means Committees: “We Are Concerned That This Guidance Is Unlawful, Will Raise Costs For Older And Vulnerable Americans, And Will Eliminate Protections For Individuals With Pre-existing Conditions.” “The interpretation disregards both the plain text of the statute, as well as the congressional intent behind Section 1332, which was to allow states to innovate to expand coverage, affordability, and comprehensive benefits. Having ‘access’ to coverage is not the same thing as having coverage, and the Administration’s attempt to read ‘access’ into the statute is transparently motivated by an ideological opposition to the benefits and protections afforded by the ACA.” [Letter To Sec. Azar, 11/29/18]